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My Favorite Way to Die: A multiple choice test

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page

Now this is definitely a weird topic but here goes:

I have cared for people who have died in almost every way imaginable. I have seen people die from decapitation, a hole shot through the heart, and those who have “simply” fallen over dead from a sudden heart attack. Those are quick but possibly painful ways to “go.” In contrast, I have cared for those who have slowly died over the course of years: Alzheimers, where the brain is dying long before the body catches up; Emphysema, where the lungs slowly lose their wind, to name a few of the chronic disease-pathways to death.

But by far, my favorite way to die, is by a sudden massive brainstem hemmorrage. I am envious of people who get to end life this way. However, the likelihood is that you and I will die some other way, likely of one of those chronic-illness pathways or natural decline. So, here is why I am fond of the sudden brainstem hemmorrhage. It is based on my experience with two men in their late 70s who were in previously good health.

Patient A, was a man who was known as the “life of the party,” always quick to put a smile of the face of strangers and loved ones alike. This gentleman spent the last day of his life doing what he always did. Apparently, he was sitting on a rocking chair on the front porch of a friend’s home, cracking jokes. In the middle of hysterical laughter, he fell over unresponsive and never woke up again. He was flow by helicopter to my care and I pretty much knew what had happened to him when I walked into the room: his blood pressure was through the roof, his pupils were tiny and pinpoint and he was basically brain-dead. As I apologized to the family for this terrible occurence but simultaneously sought to assure them that this gentleman had not suffered, a daughter interrupted me and said, “Doctor, this is the way he wanted to go. He would have wanted to be with his friends, telling jokes. And, if he could talk to us right now, he would say, “Good days people, we’ve had good days.” I found myself thinking, “Wow, what a way to go. I’m jealous.”

Patient B was a man who had “lived life on his own terms,” according to his family. He had been visiting all day with his son and they were talking about their next gambling trip. The patient remarked, “I’ve got a headache and I never have headaches.” Those were the last words he ever said. But, I had learned from patient A and in explaining patient B’s prognosis to his family, I said, “When I am 78, if I can spend my days doing what I love and then “go” like this, I will consider it a blessing. You are awake, you are yourself and then you are gone. We all die and I call this kind of death a blessing.” You should have seen the looks of shock and surprise, but then an “Ah-ha” moment occured in the room and they got it. Everyone began to nod their heads, “Me too,” a few of them said.

Now, I want to confess why this is my preferred way to die: these sudden brain stem hemmorhages often plunge you directly into a coma and just like you, I want to avoid suffering. Sure, all of us would like special time for sharing the “I love you’s” and “Goodbyes” before keeling over like my patients, but overall I will bet that everyone reading this would like to be in great shape when they “go” regardless of “how” they leave. No one wants to spend years lying in a bed hovering around death but not quite there yet (one foot in the grave and another on a banana peel to quote a folk-wisdom-filled relative of mine). Even more explicitly stated: No one I know wants to suffer and then linger in suffering before the end of life. Ergo, we must be super-careful regarding the choices we make for ourselves and those whom we love when that time arrives.

So, here is a thought provoking multiple choice question: What is your favorite way to die? Would you rather it be said of you:

A-She died while planting red tulip bulbs

B- She died in her rocking chair holding “Cookie” her pet cat, or

C- She died in the intensive care unit at 2 am after a long fight with cancer

or D. (Insert your own ideal dying here)

I know the answer to my test. What is the answer to yours?

The answer to your test should be used as the key when making medical choices at the end of a long life or at the end of a terminal illness.

(See, I told you this was a weird one, but this kind of in-your-face article was written to shake up your thinking. However, I will remind you that I do not support Physician Assisted Suicide or Euthanasia. Yet, I do believe we should be very careful to prevent unneccessary suffering at the natural end of life.)

"It's OK to Die" is a ground-breaking book filled with graphic stories straight out of the Emergency Room illustrating how most Americans are completely unprepared for death and dying. In response, the authors have created a unique and comprehensive guide urging EVERYONE to prepare in advance, to assure their own peace and to prevent the suffering of their loved ones. Learn More..

31 thoughts on “My Favorite Way to Die: A multiple choice test”

Excellent article, Dr. Murphy! It’s so hard to fill in that wide-open and important option D. I’m far more certain about what I don’t want than what I do want for that moment. Hmmm. I don’t want to endanger anyone else in the moment of my own death (such as having a stroke behind the wheel of a car on the freeway), nor do I want to shock anyone too terribly (no obvious ex-sanguinating demise for me). I would like others to know I am ready and accepting at whatever age I eventually go and no matter the pain level or inconvenience. I would NOT like to be sustained artificially with little hope of recovery of my favorite faculties (such as the ability to think, communicate, and work the occasional Sudoku puzzle).

Perhaps sitting by the lake feeding the ducks on a sunny summer day with the waves lapping at my feet and my grandchildren and great-grandchildren laughing and playing in the background, the taste of dark chocolate still lingering on my tongue and the echoes of “I love you” still ringing in my heart and head… now that’s an image I can entertain. Dozing off in my chair and crossing the final threshold, sweet. Thanks for planting the seeds of thought with your quiz.

A & B !! Preferrably A. Me, too!! Much rather avoid the lingering and suffering! That long period of dying is arguably what most people truly fear. — I think it isn’t weird at all. It addresses a concern of every human being: “how will my life end?” The topic is coming into vogue in a very BIG way as boomers age and bones begin to creak. Just look at the suddenly growing popularity of Death Cafes! This is a perfect compliment to major social concerns facing us now. Talk about it! (My mantra!) That’s better than the pain of silent fear! — Once again, great article! Am I prejudiced? Yes, in favor of openness, honesty, sincerity, good-enough and well-planned death! — Thanks to you, Dr. Murphy!

Thanks for the laugh, Dr. Murphy! Couple weeks ago at a hospice IDT meeting, our medical director asked the question, how do you want to go. For the record, I will relate that one answer to that which I’ve heard is kidney failure. It is relatively painless or can be made so; it is rather quick but not sudden, and usually leads to one dying while asleep. What is your experience with death by kidney failure?

Thanks Dan! I could go for renal failure myself As long as there was no pulmonary edema and it was just a matter of getting sleepy from the renal encephalopathy. It does have some bonuses over the quick unexpected death: you can choose to die at home, you have a window of time usually to have emotional closure with those you love, and it is an expected course. Interestingly enough I once took care of a man who was choosing to die of his renal failure, he was tired of dialysis and “this life construct” as he called it. Read his interesting story here : http://oktodie.com/blog/?p=103

Monica, another great post!
Hepatic encephalopathy > hepatic coma > see ya’! My brother-in-law played a few rounds of golf, went fishing, and came home arguing about his shoes being on the proper feet while trying to get a drink from his cell phone antenna. Lactulose interrupted his exit, what would have been one of his last days spent doing what he loved. I have told my kids they won’t ever have to change MY diaper, and I hope and pray that it’s true. Take me quickly, please!

Thank you for this insightful article. Having worked in Pediatric ICU for 18 years, I have seen many untimely deaths – and during the long ones, the kids know, even if their parents think they don’t. I have decided, however, in my discussions with some of the most innocent that their are things worse than death. Most of the children are ready to go. The worst case of my career dealt with a 15 year old whose parents withheld lifesaving treatment due to their religious affiliation as their son begged to live. I was fighting for a court order to treat as I advocated for the young man’s life. I will likely never forget that afternoon when the courthouse fax came moments after he was declared dead.

Of course I would like to go quickly. But more important to me is that I go peacefully – content with the life I lived, at peace with myself and my family and others, and absent of bitterness for any suffering I may be experience – even if the death itself is traumatic.

Martha,
Lots of interesting things in your comment:
1= Kids know even if their parents think they dont…. Elizabeth Kubler-Ross said that the dying know it whether the rest of us do or not

2= Your priority is that you die at peace with life even if your death is traumatic. LOTS of wisdom here, culled from years of experience watching people grapple with what living and dying really mean. As much as I would like to die quickly too, I agree with you that the priority above all else is to have obtained final closure and peace with my existence and all of my relationships and to consciously release any fears, anger or resentment. Basically, I would like to die emotionally and spiritually “clean” for lack of a better word.

Because of your background you’ve likely been to many funerals and memorial services. You have possibly seen or experienced some wonderful ceremonies or ideas that we could add to our upcoming book, The Best Memorial Service.

Our supplemental website will include advice and experiences from families and professionals. You can see our beta site at http://www.TheBestMemorialService.com We invite you and any of your readers to contact us with ideas, advice, contacts and resources to add to it.

Brilliant article, Monica! Absolutely brilliant! We’re so proud to be associated with your efforts! Thanks to all of those who have responded and joined in the discussion, as well – they’ve given me some great ideas on how I hope I “go out” one day.

The director of our Hospice Program just forwarded your blog to our staff. I am the Volunteer Coordinator and would like to use your article/quiz for our new volunteer orientation tonight.
Both my parents died of sudden deaths ( one in his sleep from a probable full blown stroke and the other from a ruptured aneurysm ). While this shocked the family, I knew it was the way they wanted to go because it had been discussed. I only hope I am this lucky when it is my time to go.
Thanks for a great article!

Agreed — quick and painless is best, but it raises three things we all should consider:

(1) Always tell the people you love that you love them every chance you get–you might not have the opportunity to tell them again.
(2) Never go to bed angry at someone you love–or anyone else for that matter–you may not have a chance to fix it.
(3) Make sure your legal and business affairs are always in order.

I’ve already died by “sudden death”–quite a few times–and it wasn’t bad. I had a moment of panic–naturally–when I couldn’t breathe–but once I went down, that was pretty much it. The brain is merciful in that it “forgets” to be afraid or to register much of anything as it loses oxygen. Dying, for me, was infinitely easier than being “brought back,” which was very painful.

The next time I die, which I suspect will be for the final time, I would like to be floating in the Gulf of Mexico on a warm night, and looking up at the stars. I know drowning is horrible, but if you drown from congestive heart failure anyway, why not drown in the sea that I love.

My chosen way to die would be out in nature with beauty all around me making love to my beloved. Preferably on top of a beautiful mountain with snow covered cascades in the distance and and a clear view to the ocean. Both of us ascending to the higher realm as one.

Thanks you Monica, great article.My ideal way is either never to wake up, or sitting quietly watching the world go by, happy that I have achieved at least some of the things I wanted to and that I have lived a good life. Here’s hoping!

I offered my experience on “its ok to die”…and I thought perhaps it would relevant here as well.
I happen to be the survivor of a condition the Dr;s believed would be fatal in a few minutes. The nerve to my diaphragm stopped working. When it would stop, I am totally aware, and awake and know I can’t take another breath. The first time was a shocker….but with help of- CPR, the Pulmonology team, time and luck – it started up again. However, the Drs. were unable to prevent it from happening again…and perhaps the next time I would not be so lucky and would not rally.

At that time, my 14 year old daughter was standing by my hospital bed. The 3 Dr’s – my cardiologist, my pulmonologist and my neurologist – all standing there as well, tell me I had to go on a respirator or I would likely die very soon.

As I had absolutely NO interest in being hooked up to a wall for the rest of my life…I refused. My daughter cried out, “no mommy – you have to go on”. It was at that moment that my life was crystal clear and my choices jelled and solidified.

I remember clearly saying to her- Bren… I am a very happy person…I see you , I love you you are here with me, and I much rather you know that I am at peace, I love you, and I love daddy and brother. I would rather die in a few minutes happy – then be on a respirator for a long time and be 100% absolutely miserable. So, be happy for me – I am happy.

I called my brother – a very short call – and gave my daughter a hug. I was then transported by ambulance to a different hospital in a different state…..on the outside chance I would make it there and they could help me.

The fact that I survived it is not the point. For me, it drove home the point that something could happen at any moment. Many of us repeat cliches, and write poignant poems, and share words of wisdom alluding to the possibility of dying unexpectedly. Part of the pain of dying is regret. What you should have done, should have said, or should NOT have….

And so, what made my “imminent death” less troublesome, less emotionally painful, less worrisome, and more psychologically bearable was knowing my bucket list….(which when that movie came out made me nod in agreement – through tears) was as up to date as could be. Not having been to the top of the mountain yet was not a driving force of uncompleted wishes. What brought me absolute peace in those moments before I was expected to “kick the bucket” was knowing that I had said all I had to say to everyone I had to say something to…. Actually, coincidentally – I had made a “gratitude” party just months before…and invited every relative and friend that I felt a connection to – for whatever the reason, and thanked them for being in my life.
That day in the hospital with only minutes left – I felt my work was done here, and was told it was time.
They were wrong….and I continue to keep my bucket clean.

I learned from this experience that my favorite way to die is to know it is happening, say what I want, go with a clear head, and be able to assure loved ones that they are loved and that I am happy – and to be happy for me..
Laurie

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